Presentation Transcript

Critical Thinking and the Nursing Process :

Critical Thinking and the Nursing Process

Why must I think critically? :

Why must I think critically? Because a nurse is given lots of information from which they are expected to make decisions that impact patient care.
Nurses are challenged to function within their scope of practice.

Scope of Practice :

Scope of Practice

RN- Licensed Professional :

RN- Licensed Professional Two methods of entry:
Associate Degree Nursing
Bachelors of Science Degree Nursing
Delegates to CNA’s
and LPN’s Both take the same NCLEX state board exam.
Primary difference-BSN offers more career opportunity and advancement

Advanced Practice and Masters Prepared :

Advanced Practice and Masters Prepared Nurses can go on to earn Masters Degrees as your instructors have and can have many clinical specialties and education.
Nurse’s can earn Masters degrees to become primary care providers called:
Nurse Practitioners- They must take an additional exam and obtain a additional license to practice.

LPN- Licensed Professional :

LPN- Licensed Professional Diploma program
Delegates to CNA’s
Functions under the direction of the RN

Why must I think critically? :

Why must I think critically? IT IS NECESSARY TO USE THE NURSING PROCESS!!!!! The cornerstone of nursing thinking.
Assessment
Diagnosis
Planning
Intervention
Evaluation

Types of critical thinking: :

Types of critical thinking: Socratic questioning – Technique to recognize and examine assumptions search for inconsistencies separate fact from fiction:
IE. An Elderly patient comes to the doctors office weekly with different complaints and all tests have returned negative.

Deductive reasoning :

Deductive reasoning Decisions are based on a specific conclusion or belief.
Example: A nurse assumes that a geriatric African American patient will take his medication with cornbread because all Black people like cornbread.
If the patient does not want corn bread what does the nurse then:
a. develops a new plan of action
b. Evaluates the new data
c. a and b

The Nursing Process :

The Nursing Process A systematic rational method of planning and providing nursing care.
Its purpose to identify patients problems and needs so that a nursing plan of care can be developed.

Characteristics of the Nursing Process :

Characteristics of the Nursing Process

The Nursing Process :

The Nursing Process

Characteristics of the Nursing Process :

Characteristics of the Nursing Process Cyclic and dynamic nature
Client centeredness
Focus on problem-solving and decision-making
Interpersonal and collaborative style
Universal applicability
Use of critical thinking

Assessing :

Types of Assessments :

Types of Assessments Initial
Performed within a specified time period
Establishes complete database
Problem-Focused
Ongoing process integrated with care
Determines status of a specific problem
Emergency
Performed during physiologic or psychologic crises
Identifies life-threatening problems
Identifies new or overlooked problems
Time-lapsed
Occurs several months after initial
Compares current status to baseline

Rationales 1 :

Rationales 1 Correct. Identifying problems/needs is part of nursing diagnosis. For example, a client with difficulty breathing would have Impaired Gas Exchange related to constricted airways as manifested by shortness of breath (dyspnoea) as a nursing diagnosis.
Organizing the family history is part of the assessment phase.
Establishing goals is a part of the planning phase.
Administering an antibiotic is part of the implementation phase.

Evaluating :

Evaluating Measuring the degree to which goals/outcomes have been achieved
Identifying factors that positively or negatively influence goal achievement
Goal
Determine whether to continue, modify, or terminate the plan of care

Evaluation :

Question 1 :

Question 1 Which of the following behaviors is most representative of the nursing diagnosis phase of the nursing process?
Identifying major problems or needs.
Organizing data in the client’s family history.
Establishing short term and long term goals.
Administering an antibiotic.

Question 2 :

Question 2 Which of the following behaviors would indicate that the nurse was utilizing the assessment phase of the nursing process, to provide nursing care?
Propose hypotheses.
Generate desired outcomes.
Reviews results of laboratory tests.
Documents care.

Rationales 2 :

Rationales 2 Hypotheses are generated during diagnosing.
Outcomes are set during planning.
Correct. During assessment, data are collected, organized, validated, and documented.
Documentation occurs throughout the nursing process.

Question 3 :

Question 3 Which of the following elements is best categorized as secondary subjective data?
The nurse measures a weight loss of 10 pounds since the last clinic visit.
Spouse states the client has lost all appetite.
The nurse palpates edema in lower extremities.
Client states severe pain when walking up stairs.

Rationales 3 :

Rationales 3 Weight is objective data that can be measured or validated.
Correct. Secondary data comes from any other source (chart, family) besides the client. Subjective data are covert (reported or an opinion).
Edema is objective data that can be measured or validated.
What the client reports is primary data.

Question 4 :

Question 4 The nurse wishes to determine the client’s feelings about a recent diagnosis. Which interview question is most likely to elicit this information?
“What did the doctor tell you about your diagnosis?”
“Are you worried about how the diagnosis will affect you in the future?”
“Tell me about your reactions to the diagnosis.”
“How is your family responding to the diagnosis?”

Rationales 4 :

Rationales 4 This question just seeks factual information.
This question can be answered with a single word.
Correct. Eliciting feelings requires an open-ended questions that seeks more than just factual information and cannot be answered with a single word.
The family can provide indirect information about the client but is not most likely to provide the most accurate information.

Question 5 :

Question 5 The use of a conceptual or theoretical framework for collecting and organizing assessment data ensures which of the following?
Correlation of the data with other members of the health care team.
Demonstration of cost-effective care.
Utilization of creativity and intuition in creating a plan of care.
Collection of all necessary information for a thorough appraisal.

Rationales 5 :

Rationales 5 Other members of the health care team may use very different conceptual organizing frameworks so data may not correlate.
Cost-effective care is more likely to occur with systematic application of the nursing process, but use of a framework for assessment alone may not accomplish this goal.
Because the framework is structured and because of the nature of client needs/problems, creativity and intuition in care planning are not assured.
Correct. Frameworks help the nurse be systematic in data collection.

Subjective Data :

Subjective Data Symptoms or covert data
Apparent only to the person affected
Can be described only by person affected
Includes sensations, feelings, values, beliefs, attitudes, and perception of personal health status and life situations

Objective Data :

Objective Data Signs or overt data
Detectable by an observer
Can be measured or tested against an accepted standard
Can be seen, heard, felt, or smelled
Obtained through observation or physical examination

Sources of Data :

Sources of Data Primary Source
The client
Secondary Sources
All other sources of data
Should be validated, if possible

Directive Approach to Interviewing :

Directive Approach to Interviewing Nurse establishes purpose
Nurse controls the interview
Used to gather and give information when time is limited, e.g., in an emergency

Nondirective Approach to Interviewing :

Nondirective Approach to Interviewing Rapport-building
Client controls the purpose, subject matter, and pacing
Combination of directive and nondirective approaches usually appropriate during the information-gathering interview

Closed and Open-ended Questions :

Closed and Open-ended Questions Closed Question
Restrictive
Yes/no
Factual
Less effort and information from client
“What medications did you take?”
“Are you having pain now?” Open-ended Question
Specify broad topic to discuss
Invite longer answers
Get more information from client
Useful to change topics and elicit attitudes
“How have you been feeling lately?”

The Interview Setting :

The Interview Setting Time
Place
Seating arrangements
Distance
Language

Frameworks for Nursing Assessment :

Post Test :

Post Test Use your clickers to complete the following post test.

Question 1 :

Question 1 Which of the following behaviors is most representative of the nursing diagnosis phase of the nursing process?
Identifying major problems or needs.
Organizing data in the client’s family history.
Establishing short term and long term goals.
Administering an antibiotic.

Rationales 1 :

Rationales 1 Correct. Identifying problems/needs is part of nursing diagnosis. For example, a client with difficulty breathing would have Impaired Gas Exchange related to constricted airways as manifested by shortness of breath (dyspnea) as a nursing diagnosis.
Organizing the family history is part of the assessment phase.
Establishing goals is a part of the planning phase.
Administering an antibiotic is part of the implementation phase.

Question 2 :

Question 2 Which of the following behaviors would indicate that the nurse was utilizing the assessment phase of the nursing process, to provide nursing care?
Propose hypotheses.
Generate desired outcomes.
Reviews results of laboratory tests.
Documents care.

Rationales 2 :

Rationales 2 Hypotheses are generated during diagnosing.
Outcomes are set during planning.
Correct. During assessment, data are collected, organized, validated, and documented.
Documentation occurs throughout the nursing process.

Question 3 :

Question 3 Which of the following elements is best categorized as secondary subjective data?
The nurse measures a weight loss of 10 pounds since the last clinic visit.
Spouse states the client has lost all appetite.
The nurse palpates edema in lower extremities.
Client states severe pain when walking up stairs.

Rationales 3 :

Rationales 3 Weight is objective data that can be measured or validated.
Correct. Secondary data comes from any other source (chart, family) besides the client. Subjective data are covert (reported or an opinion).
Edema is objective data that can be measured or validated.
What the client reports is primary data.

Question 4 :

Question 4 The nurse wishes to determine the client’s feelings about a recent diagnosis. Which interview question is most likely to elicit this information?
“What did the doctor tell you about your diagnosis?”
“Are you worried about how the diagnosis will affect you in the future?”
“Tell me about your reactions to the diagnosis.”
“How is your family responding to the diagnosis?”

Rationales 4 :

Rationales 4 This question just seeks factual information.
This question can be answered with a single word.
Correct. Eliciting feelings requires an open-ended questions that seeks more than just factual information and cannot be answered with a single word.
The family can provide indirect information about the client but is not most likely to provide the most accurate information.

Question 5 :

Question 5 The use of a conceptual or theoretical framework for collecting and organizing assessment data ensures which of the following?
Correlation of the data with other members of the health care team.
Demonstration of cost-effective care.
Utilization of creativity and intuition in creating a plan of care.
Collection of all necessary information for a thorough appraisal.

Rationales 5 :

Rationales 5 Other members of the health care team may use very different conceptual organizing frameworks so data may not correlate.
Cost-effective care is more likely to occur with systematic application of the nursing process, but use of a framework for assessment alone may not accomplish this goal.
Because the framework is structured and because of the nature of client needs/problems, creativity and intuition in care planning are not assured.
Correct. Frameworks help the nurse be systematic in data collection.

Resources :

Resources Audio Glossary
Nursing Assessment GuidelinesAssessment guidelines for various health problems, such as chest pain and gastrointestinal and respiratory issues
Seniors! Inc.An Article and tips on talking with senior citizens about tough issues
How to Recognize and Respond to Symptoms of Acute StrokeData provided by nursing site on identifying the signs and symptoms of a cerebral vascular accident